Provider Demographics
NPI:1740029024
Name:KINCAID, GERALD BOWEN (LSW)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:BOWEN
Last Name:KINCAID
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 DURHAM LN
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-8934
Mailing Address - Country:US
Mailing Address - Phone:630-247-3032
Mailing Address - Fax:
Practice Address - Street 1:1297 DURHAM LN
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-8934
Practice Address - Country:US
Practice Address - Phone:630-247-3032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.109773104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker